Personal data
Firstname*Initials *
Date of birth* * *
Zip code*House number *
TelephoneMobile *
IBAN nr.*
Name account holder*

Please fill out these check boxes:

I want to subscribe to:
Swimming lessons (national swimming certificates and other disciplines)
Waterpolo starter (Mondays)
Competition swimming
I already have the following swimming certificates:
No certificate, some swimming experience
Diploma A (Dutch swimming Certificate) Diploma B (Dutch swimming Certificate) Diploma C (Dutch swimming Certificate)
Zwemvaardigheid 1 (Dutch swimming Certificate) Zwemvaardigheid 2 (Dutch swimming Certificate) Zwemvaardigheid 3 (Dutch swimming Certificate)
Wereldzwemslagen 1 (World swim strokes 1) Wereldzwemslagen 2 (World swim strokes 2) Wereldzwemslagen 3 (World swim strokes 3)
Survival swimming 1 Survival swimming 2 Survival swimming 3
Waterpolo 1 Waterpolo 2 Waterpolo 3
Snorkeling 1 Snorkeling 2 Snorkeling 3
I prefer to have my swimming lessons on:
Thursdays Saturdays
For days and hours of competition swimming and waterpolo please consult our website.
How did you come about AZL?
From a newspaper From a folder
Via an ad on the internet I already knew AZL / I swam with AZL before
An internet search (i.e. Google). My sibling (s) are/were member of AZL
A comparison website for swim clubs Acquaintances told me about AZL.

Terms and Regulations

I want to be a member of AZL and I state to:
- agree to the regulations (statutes and regulations) of AZL.
- am informed about the following terms and conditions:
1. Membership starts on the first day of the month in which I was enrolled in swimming.
2. I will notify AZL on my cancellation at least one month before the end of the quarter by e-mail to (
3. When cancelling at a later date I acknowledge my obligation to pay an extra quarter.
4. I am (swimmer is) healthy enough to swim. When in doubt, I consult a physician.
Young children can enroll on the month they reach the age of 4.
When necessary a waiting list will be used before starting a new swimming group.
Social discount card holders:
I am holder of a discount card ("Ooievaarspas")
Number "Ooievaarspas"
With new subscriptions with a discount card your bank account number (IBAN) is also required.
Your bank account will not be credited as long (and for as far) as the "Ooievaarspas" is properly scanned and compensates the full membership.
Recurrent SEPA Authorization
Collector : Algemene Zwemvereniging Leidschendam (AZL) (Collector ID : NL70ZZZ404089400000)
Fluitpolderplein 1, 2262 ED Leidschendam, Nederland
*I agree to the following
By submitting this subscription form, I authorise AZL to send recurrent collection instructions to my bank to debit my account and my bank
to debit my account on a recurrent basis in accordance with the instructions from AZL As part of my rights, I am entitled to a refund from
my bank under the terms and conditions of my agreement with my bank. A refund must be claimed within 8 weeks starting from the date
on which my account was debited. I can consult my bank's website for instructions and conditions.
(*) Fields are mandatory
Please note extra remarks at the comment-field below (i.e. physical or mental limitations of swimmer).